Resolution of cortical lesions on serial renal scans in children with acute pyelonephritis

Agras, Koray; Ortapamuk, Hulya; Naldöken, Seniha; Tuncel, Altuğ; Atan, Ali

doi:10.1007/s00247-006-0362-4

Cited by 26 publications

(12 citation statements)

References 21 publications

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“…However, focal cortical defects on a 3-month scan might represent incompletely resolved inflammation from acute pyelonephritis rather than renal scar. Although our mean time for scintigraphy at 7.4 months was similar to the 6 months commonly used to detect permanent renal damage, and was similar between patients with and without focal DMSA defects, 2 reports found resolution of defects originally noted at 6 months with subsequent scans at ≥1 year in 9% of 32 patients and 46% of 13 patients [19,20]. Therefore our reported prevalence of focal cortical defects may overestimate true renal scar risk.…”

Section: Discussionsupporting

confidence: 57%

Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: A cross-sectional observational study of 565 consecutive patients

Snodgrass

Shah

Yang

et al. 2013

Journal of Pediatric Urology

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Purpose To determine prevalence and risk factors for renal scar in children referred for urologic assessment of febrile UTI and/or VUR. Methods Pre-determined risk factors for renal scar were prospectively recorded in consecutive patients referred for UTI/VUR. Age, gender, VUR grade, and reported number of febrile and non-febrile UTIs were analyzed with logistic regression to determine risk for focal cortical defects on non-acute DMSA. Results Of 565 consecutive children, 24 (4%) had congenital renal dysplasia and 84 (15.5%) had focal defect(s). VUR, especially grades IV–V, recurrent febrile UTI, and older age increased risk. For any age child with the same number of UTIs, VUR increased odds of renal defect 5.4-fold (OR = 5.4, 95% CI = 2.7–10.6, AUC = 0.759). Conclusions Focal DMSA defects were present in 15.5% of 565 consecutive children referred for febrile UTI and/or VUR; 4% had presumed congenital reflux nephropathy without cortical defect. All VUR grades increased risk for these defects, as did recurrent febrile UTIs and older age. However, 43% with grades IV–V VUR and 76% with recurrent UTI had normal DMSA.

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Section: Discussionsupporting

confidence: 57%

Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: A cross-sectional observational study of 565 consecutive patients

Snodgrass

Shah

Yang

et al. 2013

Journal of Pediatric Urology

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“…DMSA renal scan is able to highlight renal scars several months after resolution of acute infection. Agras, et al9 proposed that DMSA scintigraphy be performed more than 6 months after pyelonephritis for the diagnosis of renal scarring. Sometimes, it is not easy to differentiate renal scars from an acute inflammatory lesion on DMSA renal scan, which are both seen in acute infections.…”

Section: Discussionmentioning

confidence: 99%

Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux

Jang

Park

2012

Yonsei Med J

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PurposeMany pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses.Materials and MethodsWe retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)].ResultsBreakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0±8.2 months) than in boys (5.8±4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean±SD age at diagnosis of VUR in patients with breakthrough infection (1.14±3.14) was significantly younger than in those without breakthrough infection (5.05±3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028).ConclusionOur data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.

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“…It can detect acute pyelonephritis if it is used during the acute illness, but it shows renal scars secondary to acute disease in late imaging performed months after infection (Wani et al, 2016). In Tc-99m DMSA scintigraphy, wedgeshaped cortical defects and decreased renal volume associated with decreased cortical function are significant for determining renal scarring (Agras et al, 2007). In a study recommended that all children with recurrent urinary tract infections should be routinely investigated for VUR via VCUG in addition to USG and DMSA scintigraphy should be performed in non-acute period (Doğan et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Tc-99m DMSA Scintigraphy in Children with Vesicoureteral Reflux Accompanying Frequent Urinary Tract Infection

Çelikkaya

Atıcı

Atilgan

2019

Middle Black Sea Journal of Health Science

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Objective: Urinary tract infection is one of the most common diseases in childhood. Experimental studies have shown that renal damage due to urinary tract infection can be prevented by early diagnosis and treatment. The aim of this study was to evaluate the correlation between vesicoureteral reflux grade and Technetium-99m-dimercaptosuccinic acid scintigraphy in patients with frequent urinary tract infection Methods Between January and October 2017, 34 cases were diagnosed as vescoureteral reflux with voiding cystoureterography were retrospectively evaluated with Technetium-99m-dimercaptosuccinic acid scintigraphy in terms of renal scar and function. Scars and function ratios were evaluated in Technetium-99m-dimercaptosuccinic acid scintigraphy according to voiding cystourethrography grades and correlation between the vesicoureteral reflux grade and Technetium-99m-dimercaptosuccinic acid scintigraphy findings were investigated. Results: Of 34 patients, 26 (76.5%) were female and 8 (23.5%) were male. The mean age of the patients was 6.08 ± 4.03 (min: 1 month, max: 17 years). Twenty-one patients had unilateral vesicoureteral reflux and 13 patients had bilateral vesicoureteral reflux. Vesicoureteral reflux were detected in 47 of the total 68 kidneys. Conclusion: In children with vesicoureteral reflux, Technetium-99m-dimercaptosuccinic acid scintigraphy provides useful information to show the kidney damage and as the vesicoureteral reflux grade increases, the rate of kidney damage increases. Even in the case of grade 1 and grade 2 vesicoureteral reflux, which are not expected to cause renal parenchymal damage. Technetium-99m-dimercaptosuccinic acid scintigraphy is the most successful imaging method for detecting parenchymal injury.

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Resolution of cortical lesions on serial renal scans in children with acute pyelonephritis

Abstract: The renal cortical defects present at 6 months have a high rate of resolution later during follow-up. DMSA scintigraphy performed 12 months after the infection provides more reliable data regarding persistence of renal cortical lesions.

Cited by 26 publications

References 21 publications

Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: A cross-sectional observational study of 565 consecutive patients

Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: A cross-sectional observational study of 565 consecutive patients

Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux

The Efficacy of Tc-99m DMSA Scintigraphy in Children with Vesicoureteral Reflux Accompanying Frequent Urinary Tract Infection

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